Hartford Consensus Drafted Plan After Sandy Hook Shootings

A view of first responders on M Street, SE near the Washington Navy Yard on… (Getty Images )

October 21, 2013|By WILLIAM WEIR, bweir@courant.com

The Federal Emergency Management Agency has developed guidelines for responding to active-shooter events based on a plan devised by a group of physicians and emergency response officials started by a Hartford Hospital trauma physician.

The Hartford Consensus, a group that includes representatives from the Navy, the FBI, the Dallas SWAT team and elsewhere, met in Hartford during the spring and summer to develop a plan responding to mass shootings.

The Hartford Consensus was formed after Dr. Lenworth Jacobs, director of trauma and emergency medicine at Hartford Hospital, approached the American College of Surgeons about developing a response to recent mass shootings. Jacobs said he had the idea for the group after the shootings at Sandy Hook Elementary School in Newtown.

In spring this year, the group drafted a rough outline of their plan. A few months later, members developed a more detailed plan, which includes more use of tourniquets and bringing EMS into "warm zones" to more quickly treat the wounded.The plan discussed earlier this month by the American College of Surgeons in Washington D.C.

FEMA has picked up on the plan and incorporated parts into its own guidelines for responding to active-shooter and mass-casualty events. Ernest Mitchell, U.S. fire administrator for FEMA, wrote in his guidelines that "these very practical recommendations" could end up saving many lives.

FEMA Deputy Administrator Richard Serino said the guidelines are a response to a request for help on how to respond to the increasing frequency of mass-casualty events.

"A lot of places, EMS and fire departments were looking for some guidance, and this really lays it out," Serino said. "It gives them a template that they can work from."

Jacobs said the Hartford Consensus guidelines are to intended help municipalities and regions develop integrated and coordinated responses to mass casualties among the law enforcement, fire and emergency medical teams.

"You have to build a system where the most inexperienced person can function for 10 minutes," he said. "We need to build a system where the first responding group has a clear plan of action and can execute it immediately within five to 10 minutes, because after that help will come."

Part of the plan calls for emergency medical responders to get closer to the area where people are getting hurt. John Sinclair, fire chief for the Kittitas Valley Fire and Rescue in Washington state, said law enforcement agencies began changing their philosophies for responding to such events after Columbine. Fire and emergency medical services need to change their tactics also, he said.

"Our response is still in the mindset of 'Let's stay back a few blocks,' and in the meantime, you've got people who are severely injured," Sinclair said. "I feel very strongly that we needed to have a national dialogue to look at ways to get in there quicker."

Responding more quickly, Jacobs said, means setting up stations in "warm zones," which Jacobs describes as "not exactly safe, but you're not in immediate harm's way — the [shooter] can't see you."

The plan also highlights the need for wider use of tourniquets to stop bleeding. Go to a mall, Jacobs said, and you'll likely find an automated external defibrillator on the wall for emergencies. These devices can cost a few thousand dollars. But you won't find tourniquets widely available, even though they cost about $15. That's why people were ripping off their sleeves to use as makeshift tourniquets at the Boston Marathon shooting, Jacobs said.

The plan also calls for the American College of Surgeons to develop training programs for the public in applying tourniquets, comparable to how the American Heart Association increased the public's awareness of CPR.

Police officers should carry tourniquets and know how to use them, according to the plan.

"The control of hemorrhaging needs to be a baseline skill for police," said Dr. William Fabbri, director of the emergency medical support program for the FBI and a member of the Hartford Consensus. "No one's suggesting that police officers become trauma surgeons, but if we can teach an 18-year-old soldier in Iraq or Afghanistan to apply a tourniquet, we can teach a police officer."

Jacobs said he's been encouraged by the response that the plan is getting and that FEMA has incorporated parts of it.

"Now we have a lot of momentum with the national government," he said. "This has all happened between April and now, and that's unusual to have national policy generated in that short of time."